From the Guidelines
For incision and drainage of a back abscess, a longitudinal incision is generally preferred. The incision should be made parallel to the natural skin tension lines (Langer's lines) which run horizontally across the back. This approach minimizes scarring, promotes better healing, and provides adequate exposure for complete drainage. The length of the incision should be sufficient to allow thorough exploration of the abscess cavity and removal of all loculations and necrotic tissue. After making the incision, the abscess cavity should be explored with a finger or blunt instrument to break up any loculations, followed by irrigation with sterile saline. Packing the wound with iodoform or plain gauze may be necessary depending on the size and depth of the abscess. The packing should be changed daily or every other day until the wound shows healthy granulation tissue. Some key points to consider when performing incision and drainage of a back abscess include:
- The primary treatment for simple abscesses or boils is incision and drainage, and antibiotics are not needed 1.
- Antibiotics may be indicated if there are signs of surrounding cellulitis, systemic symptoms, or in immunocompromised patients 1.
- Common choices for antibiotics include cephalexin 500mg four times daily or clindamycin 300-450mg four times daily for 5-7 days 1.
- The longitudinal approach is preferred because it follows the natural anatomical planes of the back, allows for better visualization of the abscess cavity, and results in less tension on the wound during healing.
- Recent guidelines suggest that wound packing after surgical drainage of an anorectal abscess may not be necessary, and its use should be left to individual unit policy and patient discussion 1. However, the most recent and highest quality study, which is the 2021 WSES-AAST guidelines for anorectal emergencies 1, does not provide specific recommendations for the management of back abscesses. Therefore, the above recommendations are based on general principles of abscess management and may need to be adapted to the specific clinical scenario.
From the Research
Incision and Drainage of Back Abscess
- The provided studies do not specifically address the type of incision (transverse or longitudinal) for incision and drainage of back abscesses 2, 3, 4, 5, 6.
- However, the studies discuss the general principles of incision and drainage, including the importance of adequate drainage and the potential for complications such as damage to adjacent structures or spread of infection 2, 4.
- Some studies compare different techniques for incision and drainage, such as packing versus no packing, but do not address the orientation of the incision 3, 6.
- One study compares incision and drainage with incision, curettage, and suture under antibiotic cover for anorectal abscesses, but this may not be directly applicable to back abscesses 5.
- Overall, there is limited evidence to support a specific type of incision (transverse or longitudinal) for incision and drainage of back abscesses, and the decision may depend on the individual case and the surgeon's preference 2, 3, 4, 5, 6.